I am in the tail end of the baby boomer generation and the elder care industry is preparing for the Silver Tsunami we will create. I suspect that you, as well as I, have pretty much not prepared ourselves for the health care and end-of-life care we will need.

As my father's disease progresses, I find that what I am learning for my work for Caring Companion Health Care is extremely helpful for my own family. Hospice started working with my father and mother about 18 months ago. Our hospice social worker provided answers to every question I could come up with and gave us emotional support. They are a wonderful, caring, and knowledgeable group of health professionals.

I was lucky enough to attend the recent hospice conference in Bangor, ME. Women I had not met talked to me in the buffet line, at my table and in the halls. That conference room was full of kind people, working in health care. The woman seated next to me, quietly left the room during the key note speech and returned with a muffin. When I whispered "Where did you get that?" she offered it to me. I glanced down at her nametag, already guessing; yes, she was a hospice social worker.

The first thing Dr. Ira Byock, (palliative care expert, author of three books, a Dartmouth professor, and a frequent TV and radio guest), said was: "I have some bad news that I hate to tell you, but...we all are going to die". After about two seconds of shocked silence, the laughter erupted.  Of course we are all going to die, but how often do we talk about it?

Did you know that hospice is available starting 6 months before death? Right now, 1/3 of the patients use it only for 7days or less. Hospice actually provides many kinds of care, including pain management, while not hastening or postponing death, just making it easier. Dr. Byock pointed out that the end-of-life has many aspects. Relationships can be resolved. Families can talk about the meaning of life.

The most important thing I learned that day was actually the basis of his book, The Four Things That Matter Most About Living.

When your loved one is dying and you don't know what to say, say these four things:
1- Please forgive me
2- I forgive you
3- Thank you
4- I love you

As Dr. Byock says, "You will never be sorry that you did."

By Vernon Doucette,
Boston University Photography

Concord residents had a terrific opportunity to learn from one of the nation's leading Alzheimer's researchers last night as Dr Robert Stern, co-director of the Center for the Study of Traumatic Encephalopathy at Boston University's School of Medicine, spoke at the Concord Council on Aging. Stern, an excellent speaker, filled evening with both useful information and hopeful stories. 

I knew we were in for a good evening when he started off with what most would consider a professional and political No-No: he told a joke about a man suffering from Alzheimer's Disease. And his point was well-taken: successful Alzheimer's caregivers have to have a sense of humor.

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Congratulations to our own Dr. Deborah Bier, PhD!  The Home Care Association of America, the home care industry's largest trade organization, has asked her to deliver another of her popular series of webinars training professionals and families who are dealing with Alzheimer's Disease and Related Dementia (ADRD). In 2012, Debbie's first webinar was so popular that they immediately asked her to deliver three additional sessions on similar topics. We learned later that her sessions were being downloaded by agencies around the country to use in their training. Quite a compliment to her work, and a demonstration of the high quality we try to deliver at Caring Companion.

Debbie's trainings and webinars are based on a program developed by the Alzheimer's Association of Massachusetts and delivered through the state's Executive Office of Elder Affairs.  We use the approach, called "Habilitation Therapy," in training our caregivers for dementia clients.

Details of the webinar are below. 

Alzheimer's Disease and Related Dementias (ADRD) require a many resources to manage on a daily basis, draining caregiver energy, time, finances and patience. But there are proven methods to make care easier, safer, and more enjoyable for both patient and caregiver. Learn some of these little-known best practices, used successfully by both professional and family caregivers alike.

Deborah Bier, PhD, is the director of care for Caring Companion Homecare in Concord MA and has been a holistic psychotherapist for 25 years. Certified by the Commonwealth of Massachusetts's Office of Elder Affairs and the Massachusetts Alzheimer's Association, she trains dementia caregivers and coaches dementia families. Her particular expertise is in helping multi-generational families apply wellness approaches to managing chronic illness. She holds a doctorate in therapeutic counseling, and is a widely published writer and speaker specializing in health and healing.

Yesterday I attended a presentation by Dr Gregory Martin, Chief Medical Officer of Emerson Hospital in Concord MA.  Dr Martin highlighted, with justifiable pride, a recent program by Emerson to reduce their already-low rate of hospital infection. Anyone familiar with current elder care issues at hospitals knows the concern that the facilities can be a petri dish of infection, and with frail elders and compromised immune systems, the risk of becoming sicker in a place designed for healing is one of the frustrating ironies in today's health care world.

As a home care agency owner, I was particularly interested in his remarks about reducing infection for clients with catheters, since so many of our clients have them. 

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Earlier this week I attended a meeting of the New England Health Information Management Systems Socitey (NEHIMSS) about use of mobile technology in health care, including home care. The session, delivered by Dr Fernando Martinez, focused on hospital systems and issues of security and cost as well as quality of care. But I was again struck by the importance of the data collected by home care workers and the potential to improve health outcomes, reduce cost, raise patient quality of life, and lower the stress of family caregivers if the data is documented and followed by either an educated lay person (family member or non-medical case worker), so that earlier intervention can eliminate hospital stays.

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Hats off to Mary Baum, Nancy Crowley, and the team at Concord Park for their terrific PhotoVoice project! I attended the open on Thursday November 29, and it was very impressive. We had previously blogged about this project (see our post from October 31). The emotional power of the images and the descriptions reveal a lesson we always emphasize to the families of our clients and to our caregivers when we conduct training: although reasoning and language ability may decline, the emotional experience of people with dementia remains vivid. This is why it is so important to “meet them where they are.” Absent safety concerns, the immediate facts are irrelevant, but the emotional life of the person are real.

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Last weekend I attended the Aging in America 2012 conference in Washington, DC, and I had a chance to speak to a several large home care franchisors and a few networks of assisted living facilities who are considering adopting our software. While I was in Washington, I also arranged with the National Private Duty Association (NPDA) to give a webinar on family web portals and what features they can or should provide.  And in an unexpected and pleasant surprise, NPDA also invited me and Debbie Bier to give a webinar on Alzheimer's training for consumers.  All of that activity made for an exciting week and weekend!

As one would expect for a Washington DC conference,

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New technologies to help seniors, the disabled and their caregivers are being launched every day. It's a huge, growing industry worth billions of dollars annually. But there are so many new products and services coming to market that most people feel confused and overwhelmed.  Do these devices mean  real aid for aging in place, or just a new way to part elders with their money?

Learn how to sort out the "toys and gadgets" from the helpful technologies on the market today. "Aging, Disability & New Technologies: Real Hype or Real Help?" Instructors Jim Reynolds and Deborah Bier, PhD will help participants make more wise choices in this bewildering, rapidly expanding marketplace.

The session will review some of the

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Caring Companion Home Care has adopted and trains our caregivers in habilitation therapy when caring for clients with Alzheimers Disease and related dementias (ADRD). This approach was developed at the Massachusetts Chapter of the Alzheimer's Association, and is considered to be the best standard of care for all types of dementia. Sadly, it is not in as widespread use in all aspects of elder care as it should be.

Habilitation therapy is a comprehensive behavioral approach to caring for people with dementia. It focuses

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By Susanne Liebich (photo at right)

Editor's Note: This program is an excellent example of what we believe here at CCHC: that our clients are first and foremost people with challenges, not full-time patients.  The difference living this point of view is profound, as this article makes abundantly clear.

The healing power of dance… I stand here to vouch for its validity.  And in particular, I want to tell you about a technique called Dance for Parkinson’s Disease developed by Mark Morris Dance Group in 2001. This technique is not about therapy, yet it is therapeutic. It is not about exercise, yet for most, it is a wonderful workout using the whole body in different ways. Dance for Parkinson’s Disease is a pedagogy that integrates ballet with imagery, balance, mobility exercises, expression and enjoyment of the art dance. It’s about creating something aesthetically beautiful and creative with the body. It’s about appreciating dance for dance’s sake in a group setting and to explore the range of physical and creative possibilities that are still very much open to individuals with Parkinson’s.

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March 31, 2012 - Sponsored by the Metrowest Alzheimer's Partnership

Where do families turn when they realize that a parent’s memory is fading? Dealing with the emotions surrounding the onset of Alzheimer’s disease, which is the most feared illness in the U.S. after cancer, is difficult. The MetroWest Alzheimer Partnership, in collaboration with the Alzheimer’s Association, is hosting an educational program that is free and open to the public on Saturday, March 31st at Whitney Place in Natick.

Concrete help for families can be elusive as they struggle to provide daily caregiving, research local resources such as residential and day programs, and find local support networks. Especially difficult for families is when their loved one starts to exhibit some of the troubling behavior commonly associated with Alzheimer’s disease.

The event features nationally recognized Alzheimer expert, Paul Raia, Ph.D (above right).

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Thanks to The Concord Journal for publishing a story about us in in today's edition.  It's about how our Dr. Deborah Bier has become certified to teach the Alzheimer's Association's home care giver training course, and how vital it is to have trained caregivers for such patients.  Read it here online.

You want your loved one with Alzheimer's Disease or related dementias (ADRD) to be cared for at home by someone experienced in meeting their needs, right?  Someone trained specifically to care for those with dementia.  Of course!

But does experience really mean that home caregivers are offering the care that's truly right for people with such diseases?  All too often, the answer is: NO.  Caring for dementia patients is specialized and requires training for a set of skills all-too-often missing in the homecare setting.

Did you know that dementia-specific training is not included in home health aide or nursing assistant certifications? "While many home care aides have experience with dementia patients, few are actually adequately equipped to do so," said Deborah Bier, PhD, the director of Caring Companion Home Care's metrowest Boston, MA office located in Concord, MA. "As a result, many don't know or use the best, most proven approaches -- the very ones that dementia patients and their families most benefit from."  The result can be challenging behaviors difficult or even impossible to manage in the home setting. But proper training for homecare workers can help make the difference between patients being able to stay comfortably (and less expensively) at home or being institutionalized.

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Anyone who works at a Massachusetts home care agency is surrounded by a wealth of resources, but none of them is more valuable than Joanne Koenig-Coste, the nationally-known author of Learning to Speak Alzheimer's.  Joanne spoke recently at Newbury Court, an assisted living facility in Concord Massachusetts, on her passionate devotion to people with Alzheimer's over the past 40 years.  At Caring Companion, we recommend her book over all others to families and those who work with Alzheimer's people.  Anyone who has heard her speak knows that her compassion and energy flow freely from her, and many more ideas flow from her than can be captured in a single blog post. Rather than try that, I have captured three great ideas from her recent address. I'll blog on others at another time.  So for this week, here we go from Joanne:

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Joanne Koenig Coste, author of Learning to Speak Alzheimers, a nationally-recognized expert on the living with the disease, will speak at Newbury Court in Concord on Wednesday, August 10 in a presentation free and open to the public.

Coste has been an outspoken advocate for patient and family care for Alzheimers patients since 1973. She is the ground-breaking co-inventor of the compassionate, easy-to-learn and common sense approach to Alzheimer's care known as habilitation.   Using this method, patients and those who care for them devote themselves to making life as comfortable and pleasant as possible for both the patient and family.

She is constantly in demand for lectures and consultations nationwide. "We are so fortunate that she is coming here", said Jim Reynolds, CEO of Caring Companion Home Care headquartered in Concord, MA. "Many of our client families have a loved one suffering from dementia and we recommend her book over all others. I found the training I took based on her work to be the most valuable I have had about dealing with Alzheimer's sufferers."

Habilitation has won praise from health care professionals. The founding director of the National Institute of Aging, Dr. Robert N. Butler, wrote the introduction to Coste's book, and she estimates that at least 100 nursing homes and assisted-living centers have adopted her methods.

"When I first began my work in dementia care over 20 years ago, the philosophy of care and approach centered on Reality Orientation," says Claire Henry, Dementia Specialist and principle of Caring Resourcesin Norwood, MA.  "The philosophy of Habilitation Therapy has done tremendous service for the dementia client, particularly in regard to their need to preserve 'personhood'. "Coste is currently in private practice as an Alzheimer's family therapist. She also serves as President of Alzheimer Consulting Associates, implementing state-of-the-art Alzheimer care throughout the United States.

This lecture will be held at 4 pm in the North Community Room at Newbury Court, 80 Deaconess Road.  Reserve your seat by calling Deb Boyden at 978 402-8223.

Improving home care for elderly Massachusetts senior citizens has become passion of mine, and recently I was asked to address the New England Home Care Conference in Newton, MA, on how to use web technology to improve the quality of senior care, or eldercare.  So I ask the room a seemingly-obvious question: “How many of you registered for this online?” Dozens of hands went up among attendees of the largest home care conference in New England, which was the first partnership of the state home care associations in the region. I continued with more obvious questions: How many made your travel reservations online? Dozens. How many shop, pay bills, check kids’ school schedules? Dozens, dozens, dozens -- in each case, nearly everyone.

Then came the punch line.

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Challenging Behaviors and the Dementia Patient

June 8, 2011, 8:00am–10:00am
50 W Main St, Hopkinton, MA
Golden Pond Assisted Living
50 W Main St, Hopkinton, MA 01748
Breakfast: 8 am
Presentation & Q&A: 8:30-10 am
RSVP to Golden Pond by June 6 at 508 435-1250

Sleep disturbances… resistance to care… suspiciousness… sundowning… hoarding… rummaging… These challenging behaviors can be frustrating, frightening, and exhausting for families and caregivers of dementia and alzheimers patients.

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5PM Reception -- 5:30PM Presentation • RSVP at 617 566-1700

Chestnut Park at Cleveland Circle • 50 Sutherland Road • Brighton, MA 02135

Sleep disturbances… resistance to care… suspiciousness… sundowning… hoarding… rummaging… These challenging behaviors can be frustrating, frightening, and exhausting for families and caregivers of dementia patients.

But there are effective, gentle methods for dealing with such behaviors. Through presentations, case studies and discussion, this event will help you develop some of the skills needed to achieve better outcomes with dementia patients.

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Many elders refuse to take any (or enough) prescribed pain medication -- particularly opiates -- not wanting to be impaired or sleepy.  And there's good reason to worry about this; while we do want people to follow doctors' orders around prescriptions, and to have excellent pain management, opiate use can increase the risk of falls and other accidents.  And many physicians have become very sparing with pain medication, fearing addiction or misuse, so many patients end up going without adequate pain control.

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